keep smiling

10 Delicious and Nutritious Meals to Fuel Your Healthy Diet

2023-03-29T01:36:00.004-07:00

Maintaining a healthy diet can be challenging, especially when it comes to finding tasty meal options. However, healthy eating doesn't have to mean sacrificing flavor. In fact, there are plenty of delicious and nutritious meals that can help you stay on track with your diet goals. In this blog post, we'll explore 10 tasty meals that are perfect for a healthy diet. From grilled salmon with roasted vegetables to lentil soup with whole grain bread, these meals are not only good for you, but they also pack a punch of flavor that will leave your taste buds satisfied. So, let's dive in and discover some healthy and delicious meal ideas that you can enjoy any day of the week.

1. Grilled salmon with roasted vegetables: This meal features a grilled salmon fillet served with a side of roasted vegetables such as asparagus, bell peppers, and zucchini.

2. Quinoa and black bean salad: This salad is made with quinoa, black beans, corn, red onion, and cilantro, and is dressed with a zesty lime vinaigrette.

3. Chicken stir-fry with brown rice: This stir-fry features chicken breast, broccoli, carrots, and bell peppers, all cooked in a savory sauce and served over a bed of brown rice.

4. Lentil soup with whole grain bread: This hearty soup is made with lentils, carrots, celery, and onions, and is served with a slice of whole grain bread for dipping.

5. Grilled chicken with sweet potato fries: This meal features a grilled chicken breast served with a side of baked sweet potato fries for a healthy twist on a classic favorite.

6. Greek salad with grilled chicken: This salad is made with romaine lettuce, cucumber, tomato, red onion, feta cheese, and olives, and is topped with grilled chicken breast and a lemony vinaigrette.

7. Eggplant Parmesan with whole wheat pasta: This vegetarian dish features breaded and baked eggplant slices served over a bed of whole wheat pasta and topped with marinara sauce and melted mozzarella cheese.

8. Shrimp and vegetable skewers: This meal features skewers of shrimp, bell peppers, onions, and zucchini, all grilled to perfection and served with a side of brown rice.

9. Turkey chili with avocado: This hearty chili is made with ground turkey, kidney beans, tomatoes, and spices, and is topped with sliced avocado for a creamy and flavorful addition.

10. Veggie burger with sweet potato wedges: This meal features a delicious veggie burger made with beans, grains, and vegetables, served on a whole grain bun with a side of baked sweet potato wedges.

Discover Samsung S22 ultra that Captures Beauty

2023-03-28T01:00:00.002-07:00

Capturing the first photo in Switzerland using the Samsung S22 Ultra can be a breathtaking experience. Switzerland is a country known for its natural beauty, from its snow-capped mountains to its pristine lakes and lush green valleys. Using the Samsung S22 Ultra to capture the beauty of Switzerland's nature can be an unforgettable experience.

My own capture using samsung S22 Ultra

The Samsung S22 Ultra is equipped with a high-resolution camera that can capture every detail of the scenery. With its advanced zoom capabilities, it can capture images from a distance, making it perfect for capturing the beauty of Switzerland's natural landscapes.

here are some specific details about the Samsung S22 Ultra camera specs:

1. Main Camera: 108 MP Wide-angle camera with OIS (Optical Image Stabilization)
2. Secondary Camera: 12 MP Ultra-wide camera
3. Telephoto Camera: 10 MP Periscope camera with OIS and 10x optical zoom
4. Front Camera: 40 MP Wide-angle camera
5. Video Recording: 8K video recording at 24 fps, 4K video recording at 60 fps, and 1080p video recording at 240 fps
6. Display: 6.8-inch Dynamic AMOLED 2X display with 3200 x 1440 resolution
7. Processor: Exynos 2100 or Qualcomm Snapdragon 888, depending on the region
8. Battery: 5000 mAh battery with 25W fast charging, 15W wireless charging, and 4.5W reverse wireless charging
9. Other features: Super Slow-mo, Night Mode, Pro Mode, Hyperlapse, and more

These are just some of the camera specs for the Samsung S22 Ultra. The camera is known for its high resolution, advanced zoom capabilities, and overall quality, making it a popular choice for photographers and smartphone users alike.

Here you can check some more awesome captures of nature that you will full in love if you are a photographer or a nature lover,

Tips of my first realestate Investment

2023-03-27T10:51:00.001-07:00

First of all I didn't take a quick decision as I don't like chances with high risk, Over years of work experience I gained a good experience about realestate market.

When I thought of moving towards being a client of realestate not a sales man I thought of every point I recommend to my clients to achieve their goals in a good investment and I told my self "Remember that investing in real estate requires careful research, planning, and management. It's important to be patient, disciplined, and realistic in your expectations"

I put my own steps to have the right decision of a successful realestate investment.

Here are these tips :

1. Educate yourself: Before investing in real estate, it's important to learn about the market, types of properties, and the investment process. You can read books, attend seminars, or take courses to gain knowledge.

2. Determine your investment goals: Decide why you want to invest in real estate and what you hope to achieve. This will help you determine your investment strategy and the types of properties to invest in.

3. Set a budget: Determine how much money you can afford to invest in real estate. This will help you determine the types of properties you can afford to invest in.

4. Choose the right location: Look for areas that have a strong rental demand, a growing job market, and a stable economy. This will increase the likelihood of your property being rented and generating income.

5. Analyze potential properties: Analyze the potential properties you are interested in, including location, condition, rental income, expenses, and potential return on investment.

6. Secure financing: If you are unable to purchase the property with cash, you will need to secure financing. Look for lenders who specialize in real estate investments.

7. Hire professionals: Consider hiring a real estate agent, attorney, or accountant to help you with the investment process. They can offer advice and guidance on legal and financial matters.

And now you can have a look at my small investment which Is a kiosk in a mixed use building

American football wallpapers

2022-09-16T13:38:00.001-07:00

Here is a collection of high quality american football wallpapers.

DUBAI First visit

2022-09-16T02:27:00.002-07:00

I had one of the most beautiful shopping experiences in my life in a huge malls like DUBAI MALL or MALL OF THE EMIRATES as you can find a massive number of fashion brands and designers' stores, and also the super sale and discounts occasionally, you will find great chances.

It's a charming city that gives a cheerfulness and let you think about plans of fun as you can have alot of daily fun tours, when it was my first visit that wasn't too long but i had some great time watching the revolution of construction built on these lands, it's just super designed and super constructed you can feel how people there could adabt to perform systematically for daily life and this make them know their rights and their limits.

It's easy to find the taste of food you like as alot of international restaurants found every where like Indian, Arabian, american food etc.

Just you should find the date of good weather conditions as it got hot starting from may so you can easily check weather befor the visit decision but finally you'll be happy visiting DUBAI.

The Egyptian pound (1 EGP)

2020-11-10T08:11:00.001-08:00

This is the image of the Egyptian pound, which shows a very wonderful scene, where the first side contains the Temple of Abu Simbel, which was built during the reign of King Ramses II, and on the right and left are Pharaonic paintings, one of which is written by the beloved of Amun, born of "Raa", and the other written in it the most beautiful of them, the beloved of the goddess, "death".

FUN WITH SAMSUNG CAMERA FOCUS

2014-08-01T07:14:00.002-07:00

Every time you use your mobile camera and have a shot and a new picture saved in your gallery, this simple focus touch gives it much happiness in your shot specially for (ME) and this make it enjoyable to open my camera again to have a new focus and a new shot <3

Chess shoot

2013-10-25T08:43:00.001-07:00

Among all the smart games the chess always has a unique style of thinking or playing it takes you to another world of deep concentration then feeling that way of taking your decision that may be attacking or defensive and how exciting you become when taking a risk and win it.
This was a tutorial game to learn our friend so it was nice to have a shoot of such a moment.

Relaxation Shoot

2013-10-25T08:33:00.001-07:00

One of the most relaxing times i have ever had was that one setting in this place looking at the Nile and breathing freely with the fresh air that let me capture such an awesome moment.

Spider & Cobwebs shoot

2013-10-25T08:06:00.001-07:00

This one is so special coz there was a very nice light condition when captured and the look of the spider within the cobwebs made it more exciting and attracted me to try more than a shoot and turning off the flash light was the right choice as the lights existed was enough to give such a lovely shoot.

Random shoot through my glass

2013-10-19T05:20:00.001-07:00

Every pic taken by me is a point to remember or restore such a mode or to ensure that this moment was a special one for me.
May be my shoot is not that awesome one that admire you but we should have some of these random shoots that take us to a special moments in the time line of our lives.

My First Project

2013-10-14T03:15:00.001-07:00

This is my first project in ma lovely field of civil engineering which is a prep school "met khalaf prep school" the whole site is about 2,000 m2 and the building is 360 m2 using solid slabs and isolated footings.
Every stage was a new learning session for me that opens the closed doors of practical life.
One of the best things ever was the feeling of the team with every worker under my supervision that makes the work spirit cheerful.

My Watch Shoot

2013-10-06T10:14:00.001-07:00

This was a shoot during ma work break, it made me feel professional for a while with ma galaxy s2 camera.
Really i like amateurs life when trying to act like a professional.

My First Post To Instagram

2013-10-06T07:25:00.001-07:00

This was the first post that made me interested in instagram world and feeling exciting with every post & effect.

Happy New Year 2013 hd Wallpaper

2012-12-31T07:40:00.000-08:00

Curbing the Enthusiasm on Daily Multivitamins

2012-10-23T18:53:00.001-07:00

Carl Wiens
Can you reduce your risk of cancer by taking a multivitamin every day?
Last week, Boston researchers announced that one of the largest long-term clinical trials of multivitamins in the United States — encompassing 14,000 male physicians 50 and older, and lasting over a decade — found that taking a common combination of essential vitamins and minerals every day decreased the incidence of cancer by 8 percent, compared with a placebo pill.
Men who had already had cancer earlier in life were most likely to benefit, the study found. Cancer deaths also were lower among those who took vitamins, though that may have been a chance finding. Curiously, the vitamin regimen did not reduce the rate of prostate cancer, the most common cancer affecting men.
The researchers also looked for side effects and found that daily vitamins caused only minor problems, like occasional skin rashes.
Even though an 8 percent reduction in the overall cancer rate is fairly modest, Dr. Demetrius Albanes, senior investigator at the National Cancer Institute, said the potential public health implications were vast. “If you think of the hundreds of thousands of new cases of cancer every year, 8 percent can add up quite a bit,” he said.
Yet no one is rushing out to urge more Americans to take multivitamins. Although half the population already takes some kind of supplement, previous studies have yielded decidedly mixed results. Some trials of high doses of nutrients believed to be cancer-fighters were shut down prematurely when they backfired, driving up cancer rates instead of reducing them.
Current federal dietary guidelines and American Cancer Society recommendations encourage people to eat a balanced diet rich in fruits and vegetables. Until now, the consensus has been that there is insufficient scientific evidence to justify taking a multivitamin to prevent cancer or other chronic diseases.
Though a large trial in Linxian, China, found decreases in stomach cancer in people randomly assigned to supplements including vitamin E, selenium and beta carotene, that population suffered from chronic nutritional deficiencies, and stomach cancer was more common than in the United States.
A review by the National Institutes of Health in 2006 concluded that evidence was “insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements.” More recently, the Institute of Medicine cautioned people on vitamin D and calcium supplements, saying that most healthy adults do not need them and that high doses of calcium have been linked to kidney stones and heart disease and that high doses of vitamin D may also be harmful.
Dr. J. Michael Gaziano, a cardiologist at Brigham and Women’s Hospital and the V.A. Boston Healthcare System who is the lead author of the new multivitamin study, said the main reason to take a multivitamin was, and continues to be, to prevent nutritional deficiencies. He was reluctant to speculate about how a multivitamin might curb cancer. One of the dominant hypotheses, he noted, is that certain vitamins are antioxidants that protect aging cells against oxidative damage caused by free radicals, harmful molecules resulting from metabolic processes within cells.
The physicians study was a type of clinical trial considered highly reliable at determining cause and effect: participants were randomly assigned to take either a multivitamin or a placebo. But they were not representative of the population at large. The doctors were a fairly homogeneous, well-educated group, less racially and ethnically diverse than the population as a whole, with far fewer smokers. And, there were no women.
“The results are promising, but we want to make sure the effects would be similar and certainly not harmful across different populations,” said Marji McCullough, a nutritional epidemiologist with the American Cancer Society. “It’s worth trying to replicate these findings to see if they’re generalizable to women, smokers and others.”
Dr. McCullough also noted that there are different multivitamin combinations and the trial results would apply only to the specific formulation used in the study. Pfizer donated the multivitamins, called Centrum Silver, but the company has tinkered with the formula since the trial began — reducing the amount of vitamin A, for example, and adding the nutrients lutein and lycopene.
Generally speaking, people who take vitamins are a relatively healthy bunch to begin with, experts say. They tend to eat a varied and healthful diet, watch their weight and be physically active. It’s not always clear that the benefits they attribute to vitamins actually result from the pills.
“There’s a mystique about vitamins, that vitamins are some type of magical ingredient,” said David G. Schardt, senior nutritionist for the Center for Science in the Public Interest, an advocacy group in Washington. “There is a kernel of truth in that, because vitamins are essential to life. But that people will live longer or healthier lives if they take vitamins or eat foods fortified with vitamins — that’s difficult to prove.”
This year the center pressed Pfizer to change Centrum labels that said the multivitamins supported “breast health” and “colon health.” Such claims have to be approved in advance by the Food and Drug Administration, and even though the labels did not say explicitly that the supplements prevent cancer, the center alleged that was the implied message.
Experts are particularly concerned about letting the enthusiasm get ahead of the scientific evidence, because some vitamin trials have led to frighteningly paradoxical results. In two separate studies, smokers who were given supplements of high doses of beta carotene unexpectedly developed more lung cancers than those on placebos. Beta carotene was believed to protect against cancer, but it appears that in smokers’ lungs, the high doses actually caused DNA damage instead of protecting against it, Dr. McCullough said.
Another large study, involving 35,000 men who were given vitamin E and selenium in the hopes of reducing prostate cancers, also had disappointing results.
While deficiencies of certain nutrients can be harmful, an excess in some cases may also be bad, said Dr. Joel B. Mason, professor of medicine and nutrition at Tufts University. Like some medications, certain nutrients and vitamins may need to be delivered within a specific optimal range to confer benefit, he said, a concept he and others have termed a “Goldilocks phenomenon.”
“I think there is pretty compelling evidence that habitual underconsumption of folate does lead to an increase in colon cancer, and perhaps a few other types of cancer as well,” Dr. Mason said. “Folate is an essential factor in the synthesis and repair of DNA.”
But giving a well-nourished population folate supplements does not seem to decrease the risk further, Dr. Mason said, and some studies have indicated that “in some people who take extraordinarily large amounts of folate, there may be a paradoxical increase in colorectal cancer.”
One of the important observations of the new study is that a daily multivitamin appears to be fairly safe. That may also help shape the direction of future research, said Dr. Albanes, the senior investigator at the National Cancer Institute.
“The idea that ‘if a little is good, more is better’ led to trials with higher doses that didn’t necessarily come to fruition,” Dr. Albanes said. “This points us in the direction of the kinds of dosages that should be considered for prevention. It’s food for thought.”

View the original article here

The Hunt for an Affordable Hearing Aid

2012-10-23T18:50:00.000-07:00

Suzanne DeChillo/The New York Times
The crackling noises coming from my left ear weren’t a good sign.
Last year, when my decade-old analog hearing aid started making popping sounds, I knew I had to replace it. But because hearing aids are so costly and generally aren’t covered by insurance, I had put it off. I soon learned that in the last 10 years, purchasing a hearing aid had become even more difficult and confusing than buying a new car — and almost as expensive.
The first salesman I visited, in Los Angeles, looked at the hairline fracture on my wax-encrusted aid. He warned me that it could shatter in my ear and advised me to get a new one on the spot.
Alarmed, I visited Hearx, the national chain where I had bought my previous aids. There, a fastidious young man spread out a brochure for my preferred brand, Siemens, and showed me three models. The cheapest, a Siemens Motion 300, started at $1,600. The top-of-the-line model was more than $2,000 — for one ear. I gasped.
I’ve worn hearing aids for more than 30 years; I’ve had profound hearing loss in my right ear and moderate loss in the left ear, the one where I wear the aid, since I was 5. So I am probably savvier than most first-time customers, many of them elderly and scared of what might happen if they don’t buy an expensive aid.
A hearing aid is basically just a microphone and amplifier in your ear. It isn’t clear why it costs thousands of dollars.
But the digital era has ushered in new technology: Manufacturers boasted of Bluetooth, multiple settings, “channels” and “bands,” which processed sound and fine-tuned it like a stereo’s equalizer.
Perhaps that was why the Hearx salesman bristled when I asked what I could get for $1,000. He likened the expensive model with 16 channels to listening to an orchestra — and the eight-channel model to a car stereo. He didn’t show me any other options. It was as if I’d gone into a car lot and had been presented with only Mercedeses, Porsches and Ferraris, when I wanted to see a Honda.
Feeling pressured, I ordered the “cheap” aid. But I quickly canceled the order and started researching my options. I learned not only that now you can buy hearing aids online, but also that Costco — a place where you typically get toilet paper in bulk — has gotten into the hearing aid business.
Why have hearing aids become more expensive, while cellphones, computers and televisions have gotten cheaper? Russ Apfel, an engineer who designed a technology now found in all hearing aids, says there is no good reason for this.
“The hearing aid industry uses every new thing, like digital or a new algorithm, to raise prices,” said Mr. Apfel, whose company, Audiotoniq, aims to sell sophisticated but affordable devices. “The semiconductor industry traditionally reduces the cost of products by 10 to 15 percent a year,” he said, but “hearing aids go up 8 percent a year annually” and have for the last 20 years.
The microphones, speakers and processing chips aren’t that expensive. “Those devices in small volumes cost $10 to $15,” Mr. Apfel said. He estimated that most hearing aids cost no more than $100 to make.
Indeed, less expensive hearing aids are available online. At Audicus.com, prices run from $399 to $599, a discount made possible by eliminating the middleman — the hearing aid dispenser. “Retailers/audiologists account for up to 70 percent of the final price of a hearing aid, because they factor in a bundle of additional expensive services,” the site states.
“The big discussion right now in the industry is about unbundling,” said Audicus’s founder, Patrick Freuler. “The consumer has absolutely no idea how much is the cost of the device, how much is the cost of the service that went into testing, advising, programming, your after-sales support. All the customer sees at the end of it is one big fat price tag that says, ‘$2,000.’ ”
And all of those channels are mostly marketing. “For someone with mild to moderate hearing loss, the average hearing aid today is completely overengineered,” Mr. Freuler said. He cited studies showing that four or five channels improve speech intelligibility.
There is a downside to buying online: Hearing aids need to be mailed in for adjustments, an imperfect option.
Deborah Carlson, president of the American Academy of Audiology, said that the high prices included research and development, and pointed out that audiologists at private clinics provide customized service, including real ear measurements and repeated follow-up visits. “They’re going to understand your hearing loss better” than a Web site, she said.
Cindy Beyer, an audiologist and a senior vice president of HearUSA, the parent company of HearX, said in an e-mail that the company offers aids as low as $850 — but that the average cost of a hearing aid, according to a report from the Hearing Review and House Institute, is $3,000.
In other words, my shopping experience could have been much worse.
When I told a friend about the sticker shock, she said, “Why don’t you check out Costco?”
The chain started selling hearing aids in 1993, and now has 438 hearing aid centers. At Costco, a basic in-the-ear shell hearing aid costs $500, with the most advanced behind-the-ear models going for $1,300.
And unlike the Internet retailers, Costco offers face-to-face service with hearing aid dispensers and audiologists for custom fittings.
“As a company, we made a decision to go after this business,” said Richard Chavez, a Costco senior vice president. “I mean, to really try to become the best in the world.”
Costco’s prices are less than half than the industry standard, despite the fact that its hearing aids are produced by the same major companies, including Rexton (a brand made by Siemens) and GN ReSound. Its in-house brand of aids, Kirkland Signature, is also built by Siemens. And unlike many private hearing aid dispensers, Costco employees don’t work on commission.
Not surprisingly, Costco isn’t winning any popularity contests in the industry.
“Oh, they hate Costco,” Mr. Freuler said.
Sam Tanzer, a founder of an online store called Embrace Hearing (where prices run from $399 to $899), said that private retailers had to raise prices to cover fixed costs. “When you think about your typical independent audiologist charging $6,000 for a set of hearing aids, he’s not getting rich,” he said. “Costco just has much more efficient overheads. They don’t have to pay a receptionist; they don’t have to lease separate space.”
Admittedly, my experience at Costco was mixed. The inexperienced hearing aid dispenser suggested a brand, Bernafon, that I was not familiar with. The sound was compressed and tinny; it never sounded or fit right and had to be remade several times. After seven or so visits, I was beginning to believe the adage “You get what you pay for” (in this case, $950).
When I moved to Seattle last year, I went back to Costco and explained my situation. Though nearly a year had passed, the store accepted a complete return and gave me a new brand, which fit perfectly.
However, I may not have needed a new aid at all. Far into my Costco experience, I saw a nondescript sign in Culver City, Calif., for a hearing aid professional. I rang the doorbell, located discreetly inside an eyeglass shop, and an older man beckoned me to a small, windowless room with wood-paneled walls and shelves filled with odds and ends of the trade: hearing aid boxes, batteries, replacement parts, silicone molds.
I told him about my misadventures and he looked at my cracked, wax-encrusted aid — the one I was told was so dangerous it needed to be immediately replaced. He put a stethoscope in his ear and listened to it. He said that he could clean out the wax and have the shell repaired and that it would work just fine.
His price: $100.

View the original article here

Thinking Twice About Health Checkups

2012-10-23T18:40:00.000-07:00

In an analysis of studies including more than 180,000 subjects, researchers have found that general health checkups — like annual physicals or other visits to the doctor by asymptomatic people — are ineffective and possibly harmful.
The investigators found no evidence that an annual physical will prevent death by cancer, cardiovascular disease or any other cause. Nor did they find any effect on hospital admissions, disability, additional visits to the doctor or absences from work.
The researchers, writing in the October issue of The Cochrane Library, found that health checkups have no effect on clinical events or other measures of morbidity. But one trial found an increased rate of diagnoses of hypertension and high cholesterol, the scientists noted, and another found a 20 percent increase in the number of new diagnoses per patient.
One possible harm, the authors point out, is that the checkups can lead to unnecessary treatment of conditions that would not cause symptoms or death.
The authors acknowledge that most of the studies are old, which may make the findings less applicable to modern health settings.
“We’re not concluding that prevention is useless,” said the lead author, Dr. Lasse Krogsboll, a researcher at the Cochrane Center in Copenhagen. “One possible reason we couldn’t find an effect is that primary care physicians might be doing a good job in preventing illness, so that adding a systematic effort does not add anything except perhaps harms.”

View the original article here

David Beckham HD Wallpapers

2012-10-20T21:29:00.003-07:00

Are Doctors Too Wary of Drug Companies?

2012-10-19T05:58:00.000-07:00

Not long ago, I asked a colleague for advice on a patient. He offered up a couple of treatment options, then stopped to show me a new medical app on his electronic tablet. With a few swipes of his finger, he summoned a compilation of research articles, synopses and even entire textbooks that, printed and bound, would have filled shelves in a library.
Dr. Pauline Chen on medical care.

“But do you know what the best part is?” he asked with a twinkle in his eye. I thought of the exhaustive reference material and the seemingly endless scroll of diagnoses that were all so easy to access on the small screen balanced on his knees.

“The best part is that none of this is sponsored by Pharma!” he said with a broad smile. “There’s no bias.”

My colleague is not the only doctor who feels that way, according to a recent study published in The New England Journal of Medicine.

For years, most doctors have had a predictable, if not close, relationship with the pharmaceutical industry. Companies handed out office tchotchkes, paid for staff lunches and distributed drug samples for patients. More significantly, drug companies were important sources of biomedical research money, particularly during periods when federal support wavered. It was understood that the companies providing funding would leave the researchers alone to design and conduct the study, analyze the data and write up the results.

That understanding began to fray about a decade ago when doctors, and patients, began to realize that drug companies were becoming too involved with the research they were supporting. For example, one major pharmaceutical firm manipulated data and underestimated the risk of heart attacks, strokes and deaths in a large study of a drug for arthritis. The drug was eventually withdrawn from the market, but not before 80 million patients had used it, with annual sales topping $2.5 billion.

The case highlighted the dangers of industry sponsorship of research into new drugs, and the public became eager to expose any potential conflict of interest, particularly for doctors. Within a few years, a new standard of transparency in medicine emerged. Brightly labeled drug company pens became an embarrassment; lunches on the drug company tab and sponsored conferences turned suspect; and editors at numerous medical journals published lengthy screeds detailing their disclosure requirements.

The new skepticism and transparency were no doubt good for patients and doctors, but this recent study reveals that in our zeal to single out the pharmaceutical industry’s biases, we may have become blind to our own.

The researchers created several hypothetical drug studies, then asked a group of practicing physicians to rate the “studies” and the likelihood they would prescribe the new “drug.” The researchers purposefully varied the quality of the studies and the disclosures – some of the made-up studies disclosed that they had received pharmaceutical company funding, others said they’d received support from the National Institutes of Health, and the rest listed no funding disclosures at all.

Most of the doctors were able to assess the quality of the research pretty accurately. After reading the less rigorous studies, the ones that weren’t designed, conducted or analyzed well, the doctors were hesitant to prescribe the new drugs under study; seeing the more rigorous studies, they were more willing to do so.

But the researchers also found that the doctors were also unduly swayed by any mention of industry funding. Regardless of the quality, if a study was supported by a pharmaceutical company, doctors were less willing to consider prescribing the studied drug and less likely to assess the quality of the research with accuracy.

“Some amount of skepticism is warranted,” said Dr. Aaron S. Kesselheim, lead author of the study and an assistant professor of medicine in the division of pharmacoepidemiology and pharmacoeconomics at the Brigham and Women’s Hospital in Boston. “But ultimately it should be the quality of the study and the impact of the results that determine your confidence about using a new drug, not who was funding it.”

Being overly skeptical has serious implications for patient care. The pharmaceutical industry, along with medical device and biotechnology firms, continues to finance a majority of current research. In 2007, for example, industry was responsible for nearly 60 percent of the more than $100 billion spent on research. Much industry-supported research focuses on the side effects of new drugs. By writing off such research, doctors risk overlooking findings that may have important treatment implications for their patients, like a new cholesterol-lowering drug that is found to have less of an effect on energy and blood sugar levels than other similar medications.

Dr. Kesselheim and his collaborators believe what is needed in biomedical research is even greater transparency. Such openness would include more independent third-party statistical reviews to ensure that data is not being manipulated or misleading and wider use of public Web sites like ClinicalTrials.gov, regardless of the source of funding.

ClinicalTrials.gov lists study details like objectives, design and data gathered, providing doctors and patients alike with a way to confirm that no data is being selectively reported or distorted. But participation on the site is voluntary, and pharmaceutical, medical device and biomedical companies are often hesitant to share what they consider proprietary data, choosing instead to list only selective details, or no information at all.

Until full transparency is achieved and such details are available to all on the Web or for independent statistical reviews, Dr. Kesselheim and his collaborators suggest that both doctors and patients remain alert to potential biases — Big Pharma’s, and also their own.

“Excessive skepticism,” Dr. Kesselheim observed, “is as much a bad thing as naïveté.”

Dr. Pauline Chen on medical care.

View the original article here

Cholesterol Is Falling in Adults, Study Finds

2012-10-17T19:22:00.000-07:00

Cholesterol levels in adults are falling, and changes in the amount of trans fats in the American diet may be part of the reason, new research suggests.

The findings, published Tuesday in The Journal of the American Medical Association, were celebrated as something of a triumph by health authorities, who said the data showed that the nation had reached its 2010 goal of getting the average total cholesterol level in adults below 200 milligrams per deciliter. Researchers examined a nationally representative sample of tens of thousands of Americans over the last two decades and recorded a decline of 10 points in average total cholesterol — to 196 mg/dL from 206 mg/dL.

While the so-called bad cholesterol decreased, there was a slight uptick in HDL cholesterol, higher levels of which are associated with a reduced risk of heart disease. Triglycerides, which are also linked to heart disease, initially rose 5 points to 123 mg/dL from 1994 to 2002, then dropped to 110 mg/dL by the end of 2010.

The study’s authors said they were buoyed by their observations, but could not provide a solid explanation for them.

The popularity of cholesterol-lowering drugs like statins was only part of the explanation, they said. Their use more than quadrupled among adults during the study period, to 15.5 percent from 3.4 percent. As many as 35 percent of men and women over 50 took them, the study found.

But the same improvements in cholesterol profiles were also seen in adults who were not taking them, said Margaret D. Carroll, the study’s lead author and a statistician with the National Health and Nutrition Examination Survey at the Centers for Disease Control and Prevention.

“It was somewhat of a surprise to us to see these favorable trends in people who were not on lipid-lowering medications,” she said.

The study was observational, which means it could not prove what caused the decline in cholesterol levels. Dr. Carroll and her colleagues said, however, that exercise, obesity and saturated fat intake were unlikely to have been significant factors. Average physical activity levels have not increased, more than a third of the adult population is obese, and the intake of saturated fat as a percentage of calories in the American diet is the same as it was over a decade ago.

Instead they suggested widespread public health campaigns to rid trans fats from foods might have had an impact.

Once widely found in fried and packaged foods, trans fats, which can raise LDL and lower HDL cholesterol, have been slowly stripped from the food supply as cities have banned their use in restaurants and pressed companies to remove them from cookies, soups, crackers and other processed foods. One C.D.C. study this year found that since 2000, levels of trans fats in Americans’ bloodstreams had fallen nearly 60 percent.

Two other trends in the last decade may have also been factors, the researchers said: declines in smoking and a drop in carbohydrate consumption.

Dr. David J. Frid, a cardiologist at the Cleveland Clinic, said the findings were unexpected given the high rates of obesity and Type II diabetes. He pointed to research showing a recent 30 percent drop in deaths from heart disease nationwide, and said the cholesterol data might be related.

The notion of trans fat consumption contributing to the fall in cholesterol numbers, while intriguing, has not been proven, said Dr. James A. Underberg of the NYU Center for the Prevention of Cardiovascular Disease.

Dr. Underberg said that standard measures of cholesterol could be deceiving. People who are obese or have Type II diabetes can have seemingly normal levels of LDL, but also have high amounts of the small LDL particles that drive into artery walls and cause heart disease.

View the original article here

Are You Likely to Respond to Exercise?

2012-10-13T21:37:00.000-07:00

Kristian Sekulic/Getty Images
Research has confirmed that people’s physiological responses to exercise vary wildly. Now a new genetic test promises to tell you whether you are likely to benefit aerobically from exercise. The science behind the test is promising, but is this information any of us really needs to know?
Gretchen Reynolds on the science of fitness.

The new test, which is being sold by a British company called XRGenomics, is available to anyone through the company’s Web site and involves rubbing inside your cheek with a supplied swab and returning the tissue sample to the company. Results are then available within a few weeks. It is based on a body of research led by James Timmons, a professor of systems biology at Loughborough University in England, and colleagues at the Pennington Biomedical Research Center in Louisiana and other institutions.

That original research, published in a landmark 2010 study, looked into the genetics of why some people respond to endurance exercise so robustly, while others do not. Some lucky men and women take up jogging, for example, and quickly become much more aerobically fit. Others complete the same program and develop little if any additional endurance, as measured by increases in their VO12 max, or their body’s ability to consume and distribute oxygen to laboring muscles.

For the 2010 study, Dr. Timmons and his colleagues genotyped muscle tissue from several groups of volunteers who had completed 6 to 20 weeks of endurance training. They found that about 30 variations in how genes were expressed had a significant effect on how fit people became. The new test looks for those genetic markers in people’s DNA.

“The idea is to help people to understand why” they might be progressing more slowly in an exercise program than their training partners are, says Dr. Timmons, one of the founders of XRGenomics.

After he appeared on a BBC science program last year, in the course of which the host was revealed to be a “low” responder, according to his gene profile, Dr. Timmons was inundated with e-mails and calls requesting the test, he says. At that point, he and several colleagues filed a patent (still pending) for the gene markers and brought the test to market.

It joins other, less-sophisticated exercise-related gene test kits already available over the counter. These tests, which are not monitored by the Food and Drug Administration, typically rely on a single gene marker and claim to be able to predict whether you — or your child — will have success as a distance runner, say, or as a power-based athlete, like a sprinter.

Their actual predictive value, based on the best currently available genetic science, “is approximately zero,” says Claude Bouchard, a professor of genetics at Pennington, who was the senior author of the 2010 study with Dr. Timmons, but has no involvement with XRGenomics. (He is a paid consultant for another company, Pathway Genomics, that offers gene tests only through physicians.)

The new test is almost certainly more reliable, with “a much stronger scientific basis than any of the previous exercise-related DNA test kits,” says Tuomo Rankinen, a professor of genetics at Pennington, who, like Dr. Bouchard, was an author of the original gene study but has no involvement with XRGenomics. But, he adds, it relies on VO12 max, just one measure of how someone responds to exercise, so it has severe limits.

The new test will not tell you, for example, how exercise might affect your blood pressure over the long haul, Dr. Rankinen says, or whether your insulin sensitivity might change, or whether you’ll lose weight. The genetic markers related to these health responses to exercise are quite different from those related to VO12 max, he says.

In other words, the scientific understanding of how our DNA affects our overall bodily response to exercise is in its infancy.

Which does not mean that anyone curious — and deep-pocketed — enough to take the test should refrain from doing so. At present the basic test kit costs about $318 (199 British pounds) for genotyping and a brief accompanying report. For about $478, you receive a more extensive explanation of the findings, along with customized exercise recommendations from the company’s scientific advisory board. The report might suggest, Dr. Timmons says, that if you are a “low” responder to endurance exercise, you should concentrate on resistance training or otherwise refocus your training.

“What we hope,” he says, is that the test and report “will encourage people to keep exercising” who might otherwise have quit when running or swimming didn’t make them more fit.

On the other hand, some people might look on the news that they are a “low” responder to endurance training as a license to quit working out altogether, he acknowledges.

But Dr. Bouchard says that that would be the worst message to take from any gene testing. “This is a good test, as far as it goes,” he says. But genes will never be destiny.

In the original 2010 gene study, the authors concluded that the gene profile they’d uncovered accounted for at least 23 percent of the variation in how people responded to endurance training, which, in genetic terms, is a hefty contribution. That leaves perhaps 77 percent of how you respond to exercise consciously up to you.

View the original article here

Do Exercise Programs Help Children Stay Fit?

2012-10-12T06:20:00.000-07:00

Thor Swift
Getting children to be more physically active seems as if it should be so simple. Just enroll them in classes and programs during school or afterward that are filled with games, sports and other activities.
But an important new review of the outcomes of a wide range of different physical activity interventions for young people finds that the programs almost never increase overall daily physical activity. The youngsters run around during the intervention period, then remain stubbornly sedentary during the rest of the day.
For the review, which was published last week in the British medical journal BMJ, researchers from the Peninsula College of Medicine and Dentistry in England collected data from 30 studies related to exercise interventions in children that had been published worldwide between January 1990 and March 2012.
To be included in the review, the studies had to have involved children younger than 16, lasted for at least four weeks, and reported objectively measured levels of physical fitness, like wearing motion sensors that tracked how much they moved, not just during the exercise classes but throughout the rest of the day. The studies included an American program in which elementary school-age students were led through a 90-minute session of vigorous running and playing after school, three times a week. Another program involved Scottish preschool youngsters and 30 minutes of moderate physical playtime during school hours, three times a week.
In each case, the investigators had expected that the programs would increase the children’s overall daily physical activity.
That didn’t happen, as the review’s authors found when they carefully parsed outcomes. The American students, for instance, increased their overall daily physical activity by about five minutes per day. But only during the first few weeks of the program; by the end, their overall daily physical activity had returned to about where it had been before the program began. The wee Scottish participants actually became less physically active over all on the days when they had the 30-minute play sessions.
The review authors found similar results for the rest of the studies that they perused. In general, well-designed, well-implemented and obviously very well-meaning physical activity interventions, including ones lasting for up to 90 minutes, added at best about four minutes of additional walking or running to most youngsters’ overall daily physical activity levels.
The programs “just didn’t work,” at least in terms of getting young people to move more, said Brad Metcalf, a research fellow and medical statistician at Peninsula College, who led the review.
Why the programs, no matter their length, intensity or content, led to so little additional daily activity is hard to understand, Dr. Metcalf said, although he and his co-authors suspect that many children unconsciously compensate for the energy expended during structured activity sessions by plopping themselves in front of a television or otherwise being extra sedentary afterward. It is also possible, he said, that on a practical level, the new sessions, especially those taking place after school, simply replace time that the youngsters already devoted to running around, so the overall additive benefit of the programs was nil.
But the broader and more pressing question that the new review raises is, as the title of an accompanying editorial asks, “Are interventions to promote physical activity in children a waste of time?”
Thankfully, the editorial’s authors answer with an immediate and emphatic “no.” If existing exercise programs aren’t working, finding new approaches that do work is essential, they say.
They point out that active children are much more likely to be active adults and that physically active children also are far less likely to be overweight. A convincing, if separate body of scientific evidence has shown that the most physically active and fit children are generally the least heavy.
So if structured classes and programs are not getting children to move more, what, if anything, can be done to increase physical activity in the young? “It’s a really difficult problem,” said Frank Booth, a professor of physiology at the University of Missouri-Columbia, who was not involved with the review.
Determining the most effective placement of classes and programs, so that they don’t substitute for time already spent running around and instead augment it, would help, he said.
But a more vital element, he said, “involves mothers and fathers,” who can encourage children to leave the couch, subverting their drive to compensate for energy expended earlier by sitting now.
A welcoming setting may also be key, the authors of the accompanying editorial wrote, pointing to a 2011 study of same-sex twins, ages 9 to 11. In that study, the most important determinant of how much the youngsters moved — or didn’t — was their local built environment. Children with more opportunities to be outside, in a safe, well-designed space, were more likely to be outside, romping.
But none of these suggestions will be easy to put in place, Dr. Booth said, or inexpensive, and all will require scientific validation. No one expected, after all, that well-designed exercise interventions for children would prove to be so ineffective.
Ultimately, he continued, the best use of resources in this field may be to direct them toward unearthing the roots of childhood inactivity. “Kids naturally love to run around and play,” Dr. Booth said. “But they’re just not doing it as much now. And we don’t know why. So what we really need to understand is, what’s happening to our kids that makes them quit wanting to play?”

Gretchen Reynolds on the science of fitness.

View the original article here

Feeling the Pressure to Drink for Work

2012-10-12T06:15:00.000-07:00

Béatrice de Géa for The New York Times COLD SHOULDER: Terry Lavin sipping seltzer water at the Pig ‘n’ Whistle in Manhattan.
As an ad-sales executive with Forbes magazine, Terry Lavin worked hard to earn his reputation as a dependable drinking buddy.
“I just basically rented space at P. J. Clarke’s,” he said, referring to the Midtown Manhattan watering hole. “I was always the last to leave, always had a cocktail in my hand.”
In a business built on likability, the role helped him succeed. Until 2010, when he decided to give his body a break and quit drinking for six months. His health got better; his business did not.
“I would call guys I was friendly with, guys who had their hands on big ad budgets, to see if they wanted to go to happy hour or get something to eat,” he recalled, “And they’d say: ‘Are you drinking? No? Don’t worry about it.’ ”
So much for the benefits of the sober life.
Even as three-martini lunches and whiskey-fueled staff meetings become harder to find outside of cable TV, plenty of American business rituals continue to revolve around alcohol. Whether it’s courting a client, sketching out a deal or simply proving you’re a team player, quaffing a round of beers is arguably more vital to many jobs than nailing a round of golf.
For professionals who abstain from alcohol — for health, religion, recovery or simple preference — it can sometimes seem harder to get ahead if you’re not willing to throw one back.
“You’re expected to drink, and drinking is part of what you do, and there’s a little bit of circumspection if you say you don’t do it,” said Link Christin, director of a special treatment program for legal professionals started last year by Hazelden, a network of alcohol- and drug-rehabilitation centers based in Minnesota. “If you say you don’t drink, you have to deal with the suspicion that you can’t play the game.”
To find that attitude in action, look no further than this year’s presidential campaign. As a part of his pitch to voters that Mitt Romney, a teetotaler Mormon, is different from most Americans, President Obama has made a conspicuous display of his own regular-guy fondness for beer.
“Yesterday I went to the State Fair, and I had a pork chop and a beer,” Mr. Obama boasted to an Iowa crowd in August the day after he closed down a beer kiosk so he could buy brews for himself and 10 other fairgoers. “And it was good. Today I just had a beer. I didn’t get the pork chop. But the beer was good, too.” The crowd rewarded him with chants of “Four more beers!”
When the public demanded that Mr. Obama release his recipes for home brews after he shared a bottle of one with a coffee shop patron in Knoxville, Iowa, the White House milked the moment by first demanding 25,000 signatures on a petition. (The White House eventually relented, releasing two recipes after just 12,000 signatures.)
It’s hardly a new tactic among politicians. Edward M. Kennedy complained about the lack of alcohol in Jimmy Carter’s White House as he prepared to challenge the president in the 1980 primaries. And it has become a pollsters’ truism in recent years that voters choose the candidate they’d rather have a beer with. (The most recent nondrinker to take the White House, George W. Bush, at least made sure he was occasionally photographed holding a nonalcoholic O’Doul’s.)
For less public figures, the notion that people who don’t drink can’t perform in business — or, worse, are somehow untrustworthy — can impede professional progress.
“There is a perception almost that you’re impotent,” said one nondrinker, an editor at a liquor-focused lifestyle magazine who asked not to be identified because many of his co-workers don’t know he recently entered a 12-step program.
Professional disadvantages to sobriety range from the literal — the editor had to decline a potential promotion because it would have involved wine tasting — to subtle.
“I regularly turn down lunches and dinners with industry people that I would have jumped at in the past,” the editor said. “I just can’t go to dinner with a winemaker and tell him: ‘No, thank you. I’m not tasting those.’ ”
One hardly has to work directly with alcohol to experience this. On Wall Street, where a “models and bottles” lifestyle prevails, those who don’t drink “complain that they can’t close a deal, can’t even get into early negotiations because they won’t engage in drinking behaviors,” said John Crepsac, a New York City therapist who counsels Wall Street workers in recovery.
Social scientists refer to it as “social capital,” the amount of economic potential to be harnessed from one’s capacity to fit in.
“There were times I knew the guys were going out with customers that could help advance my career,” said one nondrinking Wall Street trader who asked to remain anonymous because his employer doesn’t allow staff members to talk to the media, “but it was just unspoken: ‘Yeah, we won’t invite him ’cause we’ll probably get up to some drinking and he won’t partake, so what’s the point?’ ”
Of course, sobriety and success are not mutually exclusive. Warren Buffett, Donald Trump, Joseph R. Biden Jr. and Larry Ellison are all lifetime abstainers. Whether or not he wins, Mr. Romney hasn’t lacked for success, either.
And sober women might actually benefit from an old double standard. “Men are still expected to get together and go wild, but in some ways it’s frowned upon if the woman engages in it,” Dr. Crepsac said, noting that few of his female patients have complained that sobriety hurt their careers. “There are plenty of things for which women are discriminated against in the workplace, but this isn’t one of them.”
Still, research supports the idea that nondrinkers have a harder time climbing the corporate ladder. Multiple studies have shown that moderate drinkers earn more money than those who don’t drink, though heavy drinkers earn less than moderate drinkers.
That pressure to perform can sometimes cause professionals in recovery to backslide. This is one reason that Hazelden created a support group especially for lawyers who are trying to stay sober.
“The pressure to bring in business at legal firms, to be a rainmaker, is greater than ever,” said Mr. Christin, a former litigation lawyer and a recovered alcoholic. When someone must choose between supporting his or her family and having a glass of wine, it can be tough to stay the course, he said.
Teetotalers tend to develop strategies for socializing professionally without alcohol. Some will order a drink and simply leave it alone; others use humor to deflect unwanted attention. “I tell people I’m pregnant,” said the Wall Street trader (a man).
Mr. Lavin, who is on leave from ad sales to write a book, advises asking for your drink in deceiving glassware. “People are much calmer if you’re drinking a seltzer water out of a rocks glass,” he said.
And there is justice to be had. Joe McKinsey, a former mortgage executive who opened a rehab clinic for executives in East Hampton, N.Y., after his own recovery, said it had taken only a few months of being sober at his old job to go from a target of ridicule to a confidant for those in trouble.
“Eventually you get people buttonholing you, asking, ‘Do you think I have a problem?’ ” he said. “I became the go-to guy if you needed to have a private talk.”

View the original article here

Jason Statham Caricature

2012-10-11T20:41:00.002-07:00